Medicine and Health Sciences Commons^™

Improving Depression Screening In Primary Care, Grace Wilson, Annmarie O'Connor

Doctor of Nursing Practice Projects

Depression remains an increasingly prevalent and underdiagnosed disorder affecting approximately 21 million adults in the United States with only 66% seeking treatment (NIMH, 2022). Untreated depression can lead to worsening mental and physical health which negatively impacts a person’s quality of life. The implementation of routine depression screening in primary care is recommended by the US Preventive Services Task Force (USPSTF) to improve early detection leading to improved outcomes (USPSTF, 2023). Despite increased depression prevalence and USPSTF recommendation, there remained an absence of routine depression screening in a primary care practice in Midwest Illinois which led to the development of …

Increasing Annual Depression Screening For Adults In A Primary Care Setting, Sandy Zachery, Sheryl Winn, Flor Culpa-Bondal

Graduate Research Showcase

Increasing Annual Depression Screening for Adults in a Primary Care Setting

Background:

Depression is a mental illness that's common worldwide, which can cause an individual to function poorly in society and can progress to suicide. Because of several barriers, patients in a primary care environment are not being seen or treated for depression. Even though the U.S. Preventive Services Task Force (USPSTF) recommends that all adults in primary care receive annual depression screening that delivers effective treatment with the correct diagnosis and accurate follow-up, patients are still not being screened for depression.

Purpose:.

This project aims to improve …

Nurse-Led Post Stroke Depression Screening (Psd) For Patients With Acute Stroke Using Patient Health Questionnaire-9 (Phq9), Stefan Panov

Doctor of Nursing Practice Final Manuscripts

Introduction: This Evidence-Based Practice Doctor of Nursing Practice project aimed to implement a nurse-led post-stroke depression (PSD) screening using Patient Health Queastionnaire-9 (PHQ-9) in a 12-bed progressive care neuro-stroke unit at a tertiary care hospital. The first goal of this project was to detect stroke patients at risk for depression who met specific inclusion criteria. The second goal was to provide depression education, initiate social work and medical referrals, and start pharmacological treatment to reduce the medical and socioeconomic burden associated with untreated PSD before discharge from the hospital.

Background: Globally, stroke is a prominent cause of death and disability. …

Adolescent Depression Management: An Inner City Federally Qualified Health Center Program Evaluation, Aurora Wernette

Culminating Experience Projects

Background: Within the state, approximately 119,000 adolescents aged 12-17 have depression, and it is estimated that 57.8% do not receive any mental health care (National Alliance on Mental Illness [NAMI], 2021).

Objectives: The purpose of this program evaluation is to evaluate the management of adolescent depression. This evaluation focused on adolescent depression screening rates, medication prescribing and adherence, counseling referrals and initiation, barriers to treatment, follow-up visits, and parent feedback about the care received.

Methods: All adolescents who did not have previously diagnosed depression or developmental delay were included in this program evaluation., A weekly manual chart review was used …

Implementation Of Collaborative Care Intervention Within A Fqhc To Achieve Uniform Data System (Uds) Measure Of Depression Remission, Rasha A. Kafi Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Depression is one of the most common and treatable mental health conditions. Untreated depression causes emotional suffering, reduced productivity, lost wages, increased comorbidity risks, and increased healthcare costs.

Purpose: The purpose of this project was to implement Collaborative Care Interventions (CCI) to achieve the Uniform Data System (UDS) Measure of Depression Remission.

Aims: The AIMS of this project were: (a) Increases the percentage of nursing staff compliance and completion of the educational training; (b) increases nursing staff knowledge of recognition of depression signs and symptoms, early identification of depression, and administration to all adult patients; (c) Increase the percentage …

Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson

Doctor of Nursing Practice Papers

Background: Depression is not a normal process of aging; it is a diagnosable and treatable medical condition. The US Preventive Services Task Force (USPSTF) recommends that older adults be screened for depression annually.

Aim: The purpose of this evidence-based practice (EBP) project was to evaluate the depression screening process for older adults (age 65+) in a primary health care setting and provide recommendations to the primary health care clinic for improving it.

Methods: This EBP project involved collecting retrospective data from August to October 2022, including aggregate data (demographics), from all older adults who were seen in …

Overcoming Barriers To Implement Depression Screening Post-Stroke, Cameron Haeseker, Erin Morgan, Eric Wilson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Background

One-third of all stroke survivors are expected to develop post-stroke depression, which is linked to lower quality of life, impaired recovery, increased risk of recurrence and an overall increase in mortality (Robinson & Jorge, 2015).

Objectives

Despite this link, outpatient clinics including the stroke clinic of focus do not consistently use a formal depression screen. Therefore, a pilot project utilizing the framework of the IOWA Model of Evidence Based Practice to implement this American Stroke Association recommended guideline may result in a permanent adoption of screening (Iowa Model Collaborative, 2017).

Purpose

The purpose of this evidence-based practice project …

Implementation Of Phq-2 Screening Tool In A Telemedicine Based Setting, Joanna Luong

Doctor of Nursing Practice Projects

Background Major depression is one of the most common mental health disorders in the United States, affecting nearly 17.3 million of the population. As cases continue to rise throughout the ongoing pandemic of COVID-19, telemedicine has become a popular modality for accessibility to mental health care. Adequate screening, availability of resources and services, prompt treatment, and simple follow ups can contribute to treatment success rates and higher positive outcomes.

Theoretical Framework

The expanded collaborative chronic care model theoretical framework translates to this project in that it approaches management of patients with a team approach for those who screen positive for …

Improving Depression Surveillance At The We Care Clinic, Kaitlin Springer, Emma Hanney

Doctor of Nursing Practice Projects

Depression is one of the most underdiagnosed and untreated disorders affecting more than 16 million people in the United States each year (Henry et al., 2020). Unmanaged depression can lead to emotional suffering, decreased productivity, reduced income, impaired relationships, and an increased risk for comorbidities (Sinisalchi et al., 2020). It can affect anyone, however, individuals who are non-white, female, undereducated, disabled, pregnant or postpartum, have low socioeconomic status, or lack social support are at an increased risk (United States Preventative Services Task Force, 2019). The Southern Illinois University Edwardsville We Care Clinic provides primary care to minority patient populations who …

Depression Screening Upon Admission At An Addiction Facility: A Quality Improvement Project, Eric Aniekwena

Doctor of Nursing Practice

More than one in six Americans will have a diagnosis of a substance use disorder at some time in their life. According to the National Institute on Drug Abuse (2020), those with a substance use disorder will have an increased rate of having a comorbidity of depression or depression symptoms during treatment, leading to poorer outcomes. The purpose of this quality improvement project was to increase provider and staff adherence to the treatment standards outlined in the Veteran’s Affair/Department of Defense Clinical Practice Guideline for the Management of Major Depressive Disorder (Veteran’s Affairs/Department of Defense, 2016). During this 10-week process, …

An Assessment Of The Utilization Of Geriatric Depression Screenings In Primary Care Providers, Ashleigh Flora, Devi Moon, Tiffine Prisock, Shelby Reeves, Rachel Romero

MSN Research Projects

The purpose of this study was to determine the practices of primary care providers in relation to screening and treating geriatric depression. According to the Geriatric Mental Health Foundation (GMHF), depression and suicide are significant public health issues for older adults, noting that depression is one of the most common mental disorders experienced by elders. Research indicates the issue of geriatric depression is poorly approached by providers and patients do not receive appropriate care. Depression cannot be measured with lab or diagnostic tests; the only way to assess depression is to screen patients by asking questions. When screening for depression, …

It's More Than Just "Baby Blues" - Screening For Postpartum Depression In A Pediatric Setting, Breanna M. Lazar, Martha G. Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Postpartum depression (PPD) is estimated to affect up to 1 out of 7 women. Evidence and American Academy of Pediatrics (AAP) guidelines support maternal screening for PPD in a pediatric setting during well-child visits. The pediatric office is frequently visited during the first year of life and is a suitable setting to perform screening.

Aims of Service Change: Implement AAP recommended PPD screening at a busy primary care practice in Southern California using the Patient Health Questionnaire (PHQ-9).

Details of Innovation: In this pilot project, mothers (who were not patients of the pediatric practice) consented to be screened …

A Dnp-Led Educational In-Service To Increase Depression Screening In Primary Care, Shaylyn White

Doctor of Nursing Practice Final Manuscripts

Background: Depressive disorders are a major contributor to disability in the United States and worldwide. They are associated with multiple comorbid conditions including cardiovascular disease, obesity, stroke, and premature mortality. In the US, only 4.2% of primary care patients are being screened for depression and approximately 50% of cases of major depression are being missed.

Purpose: Implementation of a nurse practitioner-led educational intervention, discussing when, why, and how to screen utilizing the PHQ-2 and PHQ-9 screening tools, with the medical assistant staff in order to increase compliance with annual screening.

EBP Model/Frameworks: The Iowa model was used to guide implementation …

Multilingual Postpartum Depression Screening In Pediatric Community Health Clinics, Margo Cohen

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidence-based project is to screen all mothers for postpartum depression at their infant’s 1-week, 1-month, 2-month, and 4-month well-child visits and to educate pediatric providers and mothers on the importance of early detection, referral and utilization of mental health services.

Background: Every year, 400,000 infants are born in the United States to mothers with depression, most of which have not been diagnosed or treated. The prevalence of postpartum depression (PPD) among immigrant and low-income women following birth, is estimated to be as high as 22%. Despite their high rate of prevalence, recognition and treatment …

Depression Screening In The Primary Care Setting, Colleen Dostal, Stephanie Boerding

Doctor of Nursing Practice Projects

Recent data reveals that approximately 17.3 million adults in the US population experience an episode of depression each year. Unidentified and untreated depression has many consequences leading to a poor quality of life, direct and indirect healthcare cost-related increases, and an increase in medical comorbidities. The U.S. Preventative Services Task Force recommends that all adults be screened for depression. The PHQ-2 and PHQ-9 are the most widely accepted screening tools in the preliminary detection of depression. The purpose of this project was to educate health care professionals regarding depression and the implementation of a new depression screening protocol: A positive …

Development Of A Depression Screening Protocol For At Risk Patients Based On The Adverse Childhood Experience Questionnaire, Brittany J. Taylor

Doctoral Projects

Background: Adverse childhood experiences (ACEs) are associated with increased risk for adult depression. Utilization of the Patient Health Questionnaire Nine (PHQ-9), in combination with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSMV) criteria, aids in the diagnosis of comorbid depression and assessment of severity.

Objectives: To standardize the process of screening new adult patients at a specialty care clinic for ACEs. Then, implement a depression screening protocol based on ACE criteria to identify adult patients with comorbid depression.

Methods: Demographic, ACE score, PHQ-9 score, and protocol implementation data collected and analyzed by the Doctor of Nursing Practice (DNP) …

Depression Screening At A Mental Health Outpatient Clinic: A Quality Improvement Project, Renee Licorish

Doctor of Nursing Practice

Project Background: Depression is one of the most common mental health problems in the United States. Many individuals may seek treatment but go undiagnosed due to the lack of recognition by clinicians. Clinical guidelines recommend the use of a standardized depression screening tool within a clinician’s evaluation process. The Patient Health Questionnaire 9 (PHQ-9) is such a tool and recommended for use in the outpatient care setting. Aims of the Project: To increase depression screening of clients at a hospital-based outpatient behavioral health clinic. Purpose and Objectives: Implementation of the PHQ-9 into the clinic’s mental health assessment process to increase …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Women's Health, Charity Galgani

Dissertations

Problem: The Patient Centered Medical Home (PCMH) model of care improves health care quality and patient experience of care, and decreases costs. Depression screening is a requirement for becoming a PCMH. The purpose of this quality initiative was to obtain baseline data to describe depression screening rates among female adult patients receiving women’s health care within a Midwestern public health department seeking PCMH recognition.

Methods: The study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9 tools, and …

Risk For Depression In Coronary Heart Disease Patients Meriting Post-Coronary Artery Bypass Graft Screening; Feasibility Of Nurse-Led Cognitive Behavioral Therapy Among Patients With Depressive Symptoms, Joy L. Coles

DNP Projects

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to implement depression screening with the Patient Health Questionnaire-9 (PHQ-9) among patients with Coronary Heart Disease (CHD) who have undergone a Coronary Artery Bypass Graft (CABG) and demonstrate the feasibility of a nurse-led Cognitive Behavioral Therapy (CBT) intervention.

METHODS: A non-experimental pre-test and post-test design was completed to screen for depression among patients post CABG in the Cardiovascular Intensive Care Unit (CVICU) at a University Hospital using the PHQ-9. A sample of 21 patients were identified and selected from a convenience sample by pulling every eligible record from …

Evaluation Of Depression Screening Implementation In The Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation, Jennifer Sustek

DNP Projects

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: …

Promoting Annual Depression Screening In A Federally Qualified Healthcare Center, Denise Lesley Alleyne

Walden Dissertations and Doctoral Studies

According to the World Health Organization, depression affects about 350 million people worldwide. In 2014, only 50% of the adult patients were screened for depression in the community-based Federally Qualified Healthcare Center (FQHC) for which this doctorate of nursing practice (DNP) project was developed. In an effort to meet the 100% benchmark set nationally for the screening of adult patients in the primary care settings, the FQHC's quality improvement team now requires that 80% of adult patients in the clinic be screened for depression. Framed within the Iowa model of evidence-based practice, the purposes of this project were to: (a) …

Implementation Of A Depression Screening Protocol Specific To Implantable Cardioverter Defibrillator Patients; A Quality Improvement Project, Kendra M. Kratzwald

DNP Projects

Background: Depression in patients with implantable cardioverter defibrillators (ICD) is a problem that has not been well addressed by providers. In 2012 the American Heart Association (AHA) released a scientific statement that recommended structured and routine depression screening of these patients. The AHA statement also recommended further research on depression screening instruments and their use with this population. Aims: 1.) To develop and implement an evidenced based depression screening protocol appropriate for patients with an ICD seen in an outpatient setting. 2.) Evaluate provider knowledge about depression screening (? Is this what you mean) and depression screening practices before and …